July 25, 2024 • 42 mins
Has "food noise" ever kept you up at night? In this eye-opening episode of the Core Bariatrics Podcast, we explore the pervasive issue of constant food thoughts and how they can impact your daily life and mental health. We also delve into practical solutions, highlighting medications like Contrave that can help manage food noise effectively, and discuss how to handle those pesky cravings triggered by flavored water.
Our conversation doesn't stop at food noise. Men, this one's for you too. We dive into the societal expectations and stigmas men face when it comes to weight management, and why it's crucial to overcome them. Discover the tangible health benefits weight loss can bring—from improved fertility to better sexual health—and hear inspiring stories of transformation that go beyond physical appearance. Whether you're considering bariatric surgery or simply looking for ways to manage your weight more effectively, this episode offers valuable insights and encouragement to support you on your journey.
Our conversation doesn't stop at food noise. Men, this one's for you too. We dive into the societal expectations and stigmas men face when it comes to weight management, and why it's crucial to overcome them. Discover the tangible health benefits weight loss can bring—from improved fertility to better sexual health—and hear inspiring stories of transformation that go beyond physical appearance. Whether you're considering bariatric surgery or simply looking for ways to manage your weight more effectively, this episode offers valuable insights and encouragement to support you on your journey.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatrics Podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tami LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatrics Podcastdoes not offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Hello everybody, Before we getinto the episode, I just want to
apologize for the echo thathappens throughout the episode.
Hopefully you all can getthrough it without having to
turn it off, though if you do,we understand.
(00:43):
But thank you for continuing tolisten and let's get into today
.
Okay, maria, here is anotherday of recording.
Speaker 2 (00:51):
we are so busy we're so busy.
Speaker 1 (00:54):
We're kind of um flying by the seat of our pants
with episodes lately, justbecause we are so busy that
sometimes it's hard to touchbase with each other and record.
Speaker 2 (01:05):
So we're flying by the seat of our pants.
Speaker 1 (01:07):
I feel like we do that a lot anyways, so we've
been successful so far.
Speaker 2 (01:13):
Let me tell our listeners one thing about flying
by the seat of our pants.
I think your version, maybe myversion too flying by the seat
of your pants is the mostorganized version of some
people's lives.
Speaker 1 (01:24):
You know, you're probably not wrong.
Actually, yeah, by flying bythe seat of our pants, we do
have an outline there's anoutline.
Speaker 2 (01:30):
Not only is there an outline, but, like tammy, you
created like a hundred outlinesfor this podcast and done a ton
of background research andyou've gotten interviews with
all kinds of people.
So I think your version offlying by the seat of your pants
is my best day.
Speaker 1 (01:43):
Yeah, you're probably right.
So on one of our last episodeswe started doing fan mail, so
I'm going to start with that andthen we'll go on to.
We're actually going to talkabout men and bariatrics and
surgery and whatnot.
Speaker 2 (01:57):
So, yeah, let's do it .
Speaker 1 (01:59):
All right, let's start with the fan mail here.
We got a message saying can youtalk about food noise, weight
loss shots after surgery due tofood noise?
Um, we'll start with that,because then she also um
discusses or asked and flavoredwater, such as crystal light,
does it make you want sweets,versus having plain water?
She struggles getting water inunless it's flavored, but I also
(02:23):
.
But she also seems to wantsweets, so she battles with
wanting sweets just to have them, but it doesn't actually want
them, if that makes sense, whichit does to me.
So we'll start with the firstthing of talking about food
noise and the why people, or whyphysicians, use weight loss
shots for the food noise.
Speaker 2 (02:44):
Sure, I'm gonna let you run away with that.
Let me run away with that,because I actually will
contradict that just a littlebit, even to begin with.
So uh there's actually somereally great medications on the
market that help with not justweight loss but specifically
this food noise thing and foodnoise.
Let me just explain like whatthat that is, if someone's
wondering what that means, it'sthis constant need to be eating,
(03:07):
this constant feeling andthought of like I want food, I
want to be eating.
What's the next thing I'm goingto?
Speaker 1 (03:13):
eat.
What am I going?
Speaker 2 (03:13):
to be making for dinner oh my gosh, I don't think
I had enough earlier.
And I have actually struggledwith this because I have a
history of an eating disorderand food becomes like one of the
most, if not the most,important thought in your brain,
to the point where it kind ofdisables you from doing other
really important things in lifesometimes like job or school or
(03:34):
you know other things, and uh,it's really a mental, it's
partially mental, it's partiallyphysical.
There's lots of things that gointo that, but it's also
behavioral, like how you, howyou are trained or how you are
raised or how your environmentis structured.
There's kind of a lot offactors there and, to be honest,
the medication I prefer overall of them even over Ozempic
(03:56):
and Majaro and all the GLP-1s isactually Contrave and I think
people kind of forget sometimesthat there's actually 10 FDA
approved medications on themarket for weight management and
Comtree is one of them and it'sa combination of two
medications that were actuallydiscovered for to help people
quit smoking, because it helpswith that kind of obsessive or
(04:19):
overwhelming drive to dosomething, that kind of almost
OCD or anxiety driven need to dosomething, and whether it
affects smoking, it alsoactually affects that desire for
food.
So it actually is one of themost effective medications and
things on the market to tacklefood noise yeah, yeah, and now
explain what contrave is.
Speaker 1 (04:41):
What medications are it?
Because, if I'm not mistaken,there's two, and one of them.
A lot of people tend to be onanyways.
Speaker 2 (04:49):
Yeah, absolutely.
So.
People will be surprised thatit actually.
Yeah, it's a combination of twomedications One is bupropion
and one is naltrexone, andbupropion is also known as
Welbutrin, which is used foranxiety and depression and many
other mental health conditionsand, yeah, also used for it to
(05:09):
help people quit smoking.
Even by itself, it is very,very effective to help people
lose some weight if they've gotextra weight, and to maintain
weight.
And that's actually prettyunusual in the sense of mental
health medications, because mostmental health medications cause
people to gain weight.
So you can only imagine what itwas studied for, uh, to help
people quit smoking.
Typically, when people quitsmoking, they actually gain
(05:31):
weight because, um, there'sthere's kind of a transference
of the, the, the food behaviorwith your mouth Also just
wanting to do something inbetween doing other things or
when you're bored or just havinga habit of of some doing
something, and instead it getstransferred to eating, Right?
So typically people actuallygain weight when they stop
smoking.
But when they stop smokingusing this medication, Contrave
(05:53):
specifically, they actually lostweight and so of course the
company was like immediately onthat and had a study for the
purpose of weight management andweight loss and got it FDA
approved and it's the only typeof medication in its class.
It's actually way less expensivethan the shots, than Ozempic
and the other GLP-1 medications,and it's super underused.
(06:14):
And I am in no way sponsored oraffiliated or anything like
that with Contrave, but I willsay that in my own practice that
has been the number onemedication because it is about
equally effective.
Definitely it's less expensivefor most people, especially
without insurance, and it superaddresses that behavioral and
mental aspect of food noise andwith that I'm so sorry.
(06:35):
I feel like I snuck all the airout of the room with that one,
but no, no, you made a goodpoint there.
Speaker 1 (06:40):
that I wanted to really emphasize is that I feel
like food noise and even DrTeresa Lemasters has talked on
this that food noise really is amental I don't want to say a
mental health issue per se, Iguess, but it's mental right,
and so when you have amedication that's helping you
with that mental aspect, ithelps with that food noise
(07:03):
honestly.
So I have ADHD and my ADHD medskind of helps with that food
noise honestly.
So I have ADHD and my ADHD medskind of help with my food noise
, because without my meds I'mkind of scatterbrained all over
the place.
One of those things is food,where when I do take my meds, I
am very able to focus on work orstuff like that instead of
worrying about what I'm going toeat next.
Speaker 2 (07:23):
Absolutely, absolutely.
And actually Vyvanse is offlabel for weight management and
weight loss in part because ofthat, because a lot of people,
um, who have either foodaddiction or like over snack,
over eat, uh have have kind ofthis food noise also going on,
um, whether it leads to actuallyeating or not, but have the
(07:44):
food noise actually have ADD orADHD or features of that.
So treating that can help withfood noise.
You're absolutely right there.
So I wouldn't say food noise isin and of itself a mental
health condition or issue, butit absolutely is tied to a lot
of a lot of them.
And then not only that, but Ido think in the US especially,
(08:04):
we havea very snacking basedculture yeah, we do.
Speaker 1 (08:08):
Oh my gosh, there's so.
My boss has so many snacks inour office.
I mean chips galore, cookiesgalore.
Speaker 2 (08:14):
I'm like stop it but that's how she shows us her love
.
Speaker 1 (08:20):
honestly, I feel like , yeah, is that she's like thank
you so much for how much hardwork you guys do.
Speaker 2 (08:25):
Here's all the snacks and I'm like oh, I think we
just we come from very fooddriven cultures, even my family,
you know, coming from Russiawhen I was a kid.
We're a very food driven like.
Food is love and sharing foodis love and that's how we build
community.
Speaker 1 (08:40):
Yeah, your Thanksgiving was bombcom.
Speaker 2 (08:46):
Thank you.
I thought so too, thank you,but no.
So food is really, reallycritical in our cultures and the
the.
When we compound that with howbusy we are in our lives, it's
really tough to eat healthy andto eat full meals necessarily
that are full of like all thegood things for you.
So, uh, a snacking culture plusbeing busy plus food noise,
that's just a really tough comboto do without support.
(09:07):
Not to say that everyone needsmedications for that, but
routine definitely helps.
Cutting back where you can onyour schedule to give yourself
space and time to actually eatproperly or snack properly.
Having other kind of go-tos todeal with anxiety stress, like
working out or doing ameditating, doing other things
you really like to do, can help,but definitely medications play
(09:29):
a big role there too.
Speaker 1 (09:30):
I feel like us, as a society of we, are go, go go.
We struggle with mindful eatinglike just mindlessly eating.
Obviously, if I'm charting andof course there's chips next to
me, I'm mind mindlessly eating.
So so I think we kind of touchbase on the food noise thing and
you said you like using thosethe contrave, and some people
(09:53):
use vivance and stuff.
Um, because the weight lossshots?
Now, let's try to touch base onthat as quickly as we can, even
though it's probably a wholeepisode in itself of why those
shots might be used just forfood noise.
Speaker 2 (10:10):
Because I actually want to know the answer.
Yeah, we don't know exactly.
Again, we don't really know themechanism in terms of our
brains and the true like whatparts of the brain, what parts
of the body are interacting forfood noise?
It's probably more complex thanjust one pathway.
We do have an episode where wetalk a little bit more about the
shots, which are also calledthe OP ones like Ozempic.
(10:30):
So I do recommend, if anyone'sinterested in that, that you
kind of go to that episode formore details.
But in the same way thatContrave and other medications
hit that pathway, it seems likethese shots also address that
pathway.
That's not the primary way thatthey work, but that's
definitely one of the ways thatthey seem to work.
And I will say, actually formany people, surgery itself also
(10:53):
addresses that pathway.
It doesn't for everybody, butit does for a majority of people
.
So the combination, especiallyof like surgery plus one of the
medications if you still need itafterwards, can be even more
powerful.
So there's really all, alloptions on the table and if it's
something that you're dealingwith, I really would recommend
(11:13):
talking to a specialist, becauseI don't think this is something
a lot of primary care doctorsor generalist doctors or, you
know, just medical professionalsreally know about or know what
to do about, unless you'retalking to someone specifically
in this industry.
Speaker 1 (11:27):
We're trying to get the word out, but it's not so
quick question with that.
If you knew, if you knew, ifyou had one.
Let's say I came to you as apatient, obviously saying I have
all this food noise and I'mclearly gaining weight and but
you know, my insurance coversthe weight loss injections and I
can get it super cheap.
Would you go towards theinjections or would you still
(11:50):
start with the?
Speaker 2 (11:51):
No, I would still start with Contrave, and
actually we did that.
So, even if people havediabetes, even if people have
conditions like now uh, now, glpones and the other injectable,
the shot medications are coveredin some insurance policies,
even for, like heart conditionsand some other things like Nash
um, which is liver, fatty liverdisease Uh, even if it's covered
for the majority of people, Iwill actually still pick
(12:14):
contrave, and there's a coupleof reasons for that.
It's a pill.
It's tolerated better by mostpeople.
It doesn't have some of theside effects that the
injectables do.
It doesn't slow down thefunction of your gut, which can
be a really big side effect forpeople, especially after surgery
, when the function of your gutis already a little bit altered.
So it really yeah, and there'sdefinitely a subset of people
(12:36):
who have really bad nausea,diarrhea and other GI symptoms
that go along with the shots.
That's just super uncommon tocontrave.
So for all of those reasons, Istill stick with that medication
as my go-to not for everybody.
Everybody is still an individualand this is not advice for any
one individual.
I have to stress that this is apodcast for anyone listening,
(12:57):
so we do not give any individualmedical advice on this podcast,
nor could we.
And all providers are differenttoo, and all providers are
different too, and all providersare different, and so it also
depends on what are peoplecomfortable with?
What do people know about?
Some people who prescribeweight management medications
don't necessarily know as asmuch as others do, or don't have
a have a practice of includingthings like contrave in it.
(13:20):
So, um, I do encourage peopleto look into it, to become as
educated as they can, and it'salso kind of nice that there's
not just one possible treatmentfor this.
There's more than one,especially if people have
insurance coverage or the luxuryof being able to afford things
out of pocket.
So, in a way, like I'm actuallyreally glad that there's not
just a one size fits allsolution.
(13:41):
There's multiple options.
Speaker 1 (13:43):
Absolutely, and I think we have touched base on
this before about the flavoredwater thing, because I told you
that previously I've been ableto drink just plain water and
now, good luck, unless I amliterally dying of thirst, I
need to have crystal light in mywater.
In my water, um, now this lady,that or person that wrote in I
(14:07):
don't know if it's lady but um,does it ask if?
Does it make you want sweetsmore?
Yeah, and I have said that someof the I don't think that the
crystal light does specifically,but if I overdo the fake sugars
, I do find myself wanting sugarmore or sweets more but not
just my flavored water.
Speaker 2 (14:29):
Yeah, you know, and I think it's a matter of a little
bit of a threshold, Like if youlike.
You said like it's not anyamount, it's kind of like if you
overdo it a little bit, I willsay, um, and this is only
because, like, I grew up eatingfood different than the average
American diet.
I grew up eating food that wecooked at home.
That was kind of part of ourculture.
And I will say Russian food ingeneral, or the stuff that I ate
(14:53):
as a kid, is a lot less sweetthan than what's typical in
American culture.
So I think it's a little bit oflike what your palate is used
to.
If you're used to things thatare sweet, you're going to
continue craving things that aresweet.
Speaker 1 (15:05):
If you're used to things that are salty.
Speaker 2 (15:07):
You're going to continue craving things that are
salty, even if your body haschanged.
And then there's also we knowthat this happens again.
We don't know a hundred percentwhy or how or like how to
predict it, but people's tastechanges after surgery.
Um, it can actually changeafter any surgery that affects
the gut, but it really canchange after bariatric surgery,
(15:29):
after weight loss surgery.
So there's when you say that,like you used to drink water
plain and that was great andthat was fine, and now you can't
stomach it.
There's actually some scienceand some truth to that, but we
just don't know why.
Speaker 1 (15:42):
Why?
Yeah, and I will say that.
So Light packet usually goes inlike a 16-ounce bottle.
I'm putting it in a 40-ounceStanley cup, so maybe this
person is putting it in the16-ounce, where it is much
sweeter.
So you could try to water itdown a little more and wean your
way to less sweet.
(16:03):
You don't have to get rid of itper se, but trying to get it
less sweet maybe.
Speaker 2 (16:08):
And the weaning thing is actually really important.
Very little, very few changeshappen overnight successfully,
and when we're trying to changeour behavior, when we're trying
to change like our habits andwhat we eat, what we drink, how
we go about our day, change likeour habits and what we eat,
what we drink, how we, how we goabout our day, it I would
(16:30):
recommend taking a slow approachto those things.
So, let's say you're trying toadd a little bit of plain water,
don't start by, like you know,five extra glasses a day.
You're probably going to bemiserable and be stuck in the
bathroom all day and a lot ofother things.
Instead, try one extra glassand see how it goes for a week
or two, and the same thing withthis.
If you're trying to decreasehow sweet you drink things,
(16:51):
maybe take it down a notch alittle bit and take it down for
a week and see how you feel, andthen take it down another notch
for another week and see howyou feel, because you know how
do you eat an elephant One biteat a time, right, right,
absolutely.
I wouldn't recommendapproaching really any change in
a drastic way, because that isgoing to be a likely setup for
(17:15):
not being able to do it longterm.
Speaker 1 (17:18):
Yeah, I know people that just start drinking a
gallon of water after one dayand they're like never mind, I
can't do that.
I'm in the bathroom constantlyand it's like, well, if you
gradually work up to that gallon, your body knows what to do
with it, but if you just startthrowing water at it, it's like
what is this?
We need to get this out Totally, Totally.
Speaker 2 (17:36):
I mean, like, think of it like almost like a new job
.
Right, If you were supposed to,if you were at the expectation
where that you knew absolutelyhow to do everything in your new
job the first day that you gotthere and you were going to be
perfect at it, then maybe youshould have a different job and
maybe you should be your boss atthat job, so right.
So think of it that way whenyou're making changes, there's a
(17:57):
transition period.
So take it, take it slow andtake it over time.
And that's hard to do becauseit's not like, woohoo, I changed
something overnight, but at thesame time, it'll probably give
you a likelier chance that thatchange sticks.
Speaker 1 (18:11):
You're absolutely right, all right.
So I hope that answered thatperson's question.
So let's move into men andbariatrics.
Yes, do you know what thepercentage of men actually
getting bariatric surgery is?
Speaker 2 (18:26):
I do.
Do you know?
Do you want to guess?
Speaker 1 (18:30):
Honestly, in the year I was in the clinic there was
honestly only five, I think, soI'm going to say 3%.
Speaker 2 (18:42):
Actually it's higher than that.
So it is about 20% overall, butit varies by region.
Speaker 1 (18:48):
And I think that's where this might have been is
because we're in the Midwest orat least our practice was and
try and get these, Nevermind.
Speaker 2 (18:57):
Yes, well, yes, exactly, exactly.
So one is.
That's pretty shocking to mebecause, even though men are
just as likely to be overweightas women, in this country and
globally, like all over theworld, only our patient
population that actually getssurgery is only 20% men, so
that's basically the 80%, fourand five of the people getting
(19:21):
this kind of care are women andonly one in five is a guy, even
though the numbers are the samein terms of who actually deals
with these medical problems, andthere's actually some really
good data that shows that menwho have diabetes or men who
have heart problems or men whohave high blood pressure things
that can be related to weight,especially extra weight they
actually suffer more long-term.
(19:42):
They have higher rates of dyingyounger.
They have higher rates of dyingyounger.
They have higher rates ofhaving complications.
They have higher rates ofhaving higher costs associated
with it and even experiencinglike bad complications, like
amputations, losing a leg.
Speaker 1 (19:55):
You know you're right Now that I'm thinking about my
inpatient population.
Speaker 2 (19:59):
Yes, yes and so, and it's also in part because, like,
men are slightly likelier tosmoke, Men are slightly likelier
to smoke, men are slightlylikelier to have like lower
socio, like social support,which also is a big factor.
Speaker 1 (20:10):
So all these, things.
Speaker 2 (20:11):
It's not just like yeah, and it's not just to say
that, like weight affects menmore, right.
But given the overall pictureof like how men age a little bit
differently than women do,typically the outcomes for men
are worse when they'reoverweight than they are for
women.
Speaker 1 (20:28):
I did not know that.
Speaker 2 (20:30):
So that's all to say.
Where are the guys?
Where are the guys?
What do you think is going onhere, Tammy?
Speaker 1 (20:34):
Well, I was actually just gonna think or just gonna
say do you think some of it hasto do with how and we've touched
, based on this, on an episodetwo of how dad bods are more
accepted than a mom bod per se,or maybe us women just don't
like them as much, I don't knowI don't know, I think there's.
Speaker 2 (20:58):
I mean, it's so complex, right?
Because like we want and as aculture, I feel like we prize
like big, strong, burly dudes.
And some of that is actuallyextra weight, Like it's not
necessarily extra health, it'snot necessarily like extra like
muscle mass.
It's just people being big.
And if people are functional,if people you know are not
(21:19):
having a lot of other healthproblems, and if people are
overall healthy and they likehow they look and they like how
they function, they like howthey work, that's great.
That's not who I'm talkingabout.
What I'm talking about is, um,you're right, Like I don't think
body image is any less bad thanin men, than it is in women.
I think there is just different.
And so the body type of we wantwomen to all be skinny and you
(21:42):
know have have looked likesupermodels on billboards.
And for guys, we want them allto look like lumberjacks, Like
that's kind of the you're notwrong, and lumberjacks is
typically not what you associatewith weight loss or weight loss
surgery, so I do think that isa big part of it that I will.
I think that men especially areworried that if they go into a
(22:04):
weight loss clinic or a weightmanagement clinic and definitely
if they're discussing surgeryor medications that one they're
going to potentially lose toomuch weight, they're going to
end up looking a way they don'twant to look, oh, maybe.
Two, that it's not going towork.
Or three, that they don't wantto be there in the first place.
Right, because there's somereally good stats and data on
(22:27):
this that men in general go getcare less than women do.
Speaker 1 (22:32):
Absolutely, and they wait until it is the last resort
.
Speaker 2 (22:36):
Yes, yes.
So I think that and we've allexperienced that, like I've had
guys in my life family andotherwise I won't call anyone
out specifically who youbasically have to drag on their
deathbed to a clinic or thehospital.
So there's already someresistance to getting medical
care.
That's more in men than it isin women.
(22:57):
And then on top of it you putsomething like weight loss,
which has a lot of stigma andhas a lot of uncertainty and may
be expensive, may be painful,may change your life in ways you
don't necessarily want it to.
So you know, all those thingscombined, I think, make it
really tough for men to feelsupported and encouraged maybe
(23:17):
even by other men to go get thiskind of care, which most
providers are men.
Speaker 1 (23:22):
right, like you are in a man field, right?
Speaker 2 (23:26):
I'm always in a man field.
Speaker 1 (23:28):
So honestly, I feel like a lot of our men patients
did like seeing you as a womanprovider because maybe there was
less judgment there or not,that they felt like there was
less judgment.
Speaker 2 (23:42):
I never thought of that.
Yeah, no, that's actually.
That's pretty insightful of youand I actually had some of our
male patients say that to mespecifically.
They said I'm so glad you're awoman, I'm so glad that you're
taking care of me, I feel morecomfortable with you than if you
were a guy, which I did not.
Those were not comments I eversolicited or encouraged or asked
people for.
(24:02):
But I will say, almost everysingle one of the male patients
I had did say that out loud,even though we didn't prompt
that or anything.
So, there is maybe something tothat, that I think there's this
perception that women who aredoctors or women in healthcare
in general, are just going to bea little bit, maybe, kinder or
gentler or more accepting Maybe.
(24:24):
Maybe that's part of it.
I do think there's somethingthere, because definitely yeah.
Speaker 1 (24:28):
I said we had the best of both worlds in our
program.
We had you and another providerthat were just polar opposites
and there was nothing wrong withit.
I really said this is like thedream team, because some
patients need a provider thatgives them a little extra TLC
and attention and just caringRight.
But then there are somepatients, women and men that
(24:51):
just need to be told this iswhat you're doing, this is what,
and just be harsh and blunt andto the point.
Speaker 2 (24:59):
Yeah, and I think you're absolutely right.
You know there's circumstancesin which harsh and blunt works
well and there's people withwhom that works well.
In general, that doesn't workwell for me because as a woman,
that's just perceived totallydifferently when you do it than
when men do it on average.
So I try not to take that, thatum.
It doesn't come naturally forme with patients at all, so I
(25:19):
don't do that Um.
I will say, though I think thatsome, you know, what's
interesting too is, even though80% of the patients in this
field are women, uh, about 70 to80% of the doctors and the
healthcare providers are men inthis field.
So there's absolutely aflip-flop and that's changing.
So, like in my class, we hadmore, we started to have more
(25:40):
women that were becomingbariatric surgeons, and that
number is only increasing, butwe still have a long ways to go
there.
There's a lot of the hugemajority of people that are in
minimally invasive or bariatricor um anti-reflex surgery or
robotic surgery are men still.
So it's much more likely if yougo to get this kind of care,
that you are going to interactwith a, with a male surgeon, and
(26:03):
I do think that there's somebarriers there with men going to
see a male doctor aboutsomething as personal and
stigmatized as weight.
Speaker 1 (26:14):
Right.
Speaker 2 (26:14):
Um, but let me throw this in there.
So I think one of the thingsthat people don't know but may
change some people's minds isthat weight loss, especially
through bariatric surgery, canimprove your sex life and can
improve fertility.
Speaker 1 (26:30):
Right.
Yes, we have talked about this.
Speaker 2 (26:32):
Yes, we have a whole episode on this, because it's
one of my favorite things totalk about, because so few
people know about it and nourologist knows about it.
No OB guy knows about it.
Very few primary care docs knowabout it and definitely like
very little of the public knowsabout it.
But even though we know, likePCOS, which is polycystic
ovarian syndrome for women canbe treated with this.
(26:54):
For women who have extra weight, it can be treated with
bariatric surgery or with medsmedications for weight loss.
The same thing applies to menIf you have hormonal causes for
extra weight and that thosehormonal causes can also impact
your fertility or your sexualhealth your ability to even get
it up, have an erection havegood sex, and so 201,
(27:16):
essentially patients who gothrough this, male men who go
through this, see an improvement.
Speaker 1 (27:23):
Yeah, that's nothing.
That's something that most menare not thinking about when it
comes to losing weight.
Speaker 2 (27:32):
No, you're right and that and I know you think they
should because you say it asmuch as you- can yeah, because
like think about how much of aself-confidence boost that is,
how much of a again, like ifyou're struggling with fertility
, if you're struggling to have achild with your partner and not
even being like, not evenrealizing that weight and your
(27:53):
metabolism could be a factorright it's a factor that can be
treated and cured potentially.
Speaker 1 (27:57):
Yeah, like that's, I think, a really important
takeaway and I think that justmakes me think that you know, if
a doctor had two obese, anobese couple, come in.
You know both, both heavy, whoare, and they're struggling to
get pregnant.
Who are they looking at first?
Yes, it ain't the man.
(28:19):
They're saying oh, the womanneeds to lose weight.
Speaker 2 (28:22):
Oh, the woman needs, yeah exactly, exactly, and so I
I think that, in general, thehealth care system is, in a way,
almost built to help women andhelp like focus on women in a
way differently than men Maybenot better, but differently and
so we see weight as a problemmore for women than for men.
(28:46):
I think we judge women more forhaving extra weight than we do
men on average not everyone, buton average and I think we, we
dictate to women that they haveto do something about it more
than we do for men.
Yeah, and all of those factors,I think is also like, because
of all of that, uh, there's alot of marketing that goes out
(29:06):
to women, there's a lot ofeducation that goes out to women
, there's a lot of um, eveninsurance policy that goes out
to cover women.
There's a lot of education thatgoes out to women.
There's a lot of um, eveninsurance policy that goes out
to cover women, even though thebenefits are arguably greater
for men, because thecomplications of the extra
weight are higher for men thanthey are for women.
And uh, yeah, so, andespecially for younger men,
(29:28):
because the longer you haveheart problems, the longer you
have diabetes, the longer youhave high blood pressure, the
longer you have hormonalproblems that affect your
fertility, the worse youroutcomes will be over time.
And we also yeah, we do see mendeveloping these problems at
earlier ages than women do.
Speaker 1 (29:47):
And I just feel like men are not scared or approached
about weight and stuff as muchas women are.
We go to our appointment and,honestly, at any time our BMI is
higher than what it should be,they'll say we should lose
weight.
I don't know if that's the casewhen it comes to men as much,
so that's where I feel like menneed to get to the point of
(30:08):
having a heart attack or havingextreme diabetes before a doctor
is like oh, maybe we shouldlook into losing weight.
Speaker 2 (30:17):
Yeah, and you know that's actually.
That brings up a reallyinteresting point, because I
have a personal, personalconnection, personal somebody in
my life who recently had aheart scare, a heart problem,
and it really caused them youbring that up.
It caused them to focus ontheir weight and to actually
start asking about what are theoptions.
Do I consider surgery?
Do I consider medications?
(30:38):
They got on medications andthey did lose some weight and
they feel a lot better.
Um, they may or may not have tostay on their heart medications
, but they're at the point whereactually one of them could be
taken off because they've lostenough weight and the lost
weight also enabled them to bemore active, which enabled them
to be their their heart healthto get even better.
So, that's the other thing tothink about is, when you lose
(30:59):
weight, you're not just losingweight in a vacuum.
You're also losing weight andtherefore sometimes able to move
your body differently,sometimes able to exercise
better, sometimes able to comeoff of other medications,
sometimes you're improvingthings in a way that's not
necessarily like one plus oneequals two, but even more, and
that's really really importantto realize.
(31:20):
And, um, yeah, so I thinkthere's there's a lot to be said
, for it doesn't have to be anemergency or a crisis for
someone to really considerweight as something to tackle
whether you're a man or a woman.
Speaker 1 (31:33):
And, believe me, we welcomed men the same.
Speaker 2 (31:36):
We welcomed men, absolutely the same, and I don't
think we had a single guy whoregretted being there, regretted
going through their process,regretted going through the
procedures.
All of them 201, were like.
I had several cry in my officeafterwards because of the
results that they were seeingand how it was changing their
(31:56):
lives.
So the impact is really massive, can be really massive.
Speaker 1 (32:01):
How do we get them more comfortable of coming in?
Okay, not even just to abariatric program, but to the
doctor in general I think that'ssomething we're not going to be
able to figure out in ourlifetime to talk to some guys.
Yeah, you're not wrong yeah, sowe'll.
Speaker 2 (32:18):
we uh, we actually have a couple of folks lined up
to interview for this in thefuture, um, so that we can truly
talk to some people who, Ithink, have some good ideas
about how we get more men in thedoor and how we get more guys
thinking about this, cause Ithink really, like sex is going
to be a driver, right?
Who?
doesn't want to have better sexin their life and maybe
fertility for some, for some ofthem, um, having babies is a big
(32:40):
driver for younger guys forsure.
Uh, and then overall, justbeing able to like move your
body better and being there forthe people in your life and
being able to do your work andyou know, rocket, be confident,
be satisfied, not have to spenda lot of money on medications,
not have to worry about having aheart attack soon or down the
(33:01):
road.
I mean, I think it's, yes, Ithink there's a lot of reasons
that people could walk in thedoor or could want to, that
people could walk in the door orcould want to, but this is not
a yeah, this isn't, this is notan easy issue.
Speaker 1 (33:14):
No, yeah, those men are not easy.
No, just kidding Us women arenot easy either, but I know, I
know my husband like he doesn'twant to take a day off of work
Right, because he knows he hasto.
Okay, I have a very well-payingjob too, but he knows he needs
to provide for his family and heis also very, very wanting to
(33:35):
make sure he is there for hiswork as well, so he doesn't want
to let anybody down.
So that's when I'm just like ifyou don't go to the doctor, I'm
going to drag you there.
Speaker 2 (33:45):
I love it Well, and it's one of those like put your
oxygen mask on first kind ofsituation.
Before, like put your oxygenmask on first, kind of situation
.
Yeah, I mean like I've seenthis with a lot of guys in my
life a lot of women in my lifetoo, but a lot of guys
especially where you just driveyourself until exhaustion and
then at the point of exhaustionyou're not really useful to
anyone, you're not useful toother people, you certainly
(34:05):
aren't useful to yourself, andgetting to that point is kind of
awful in a lot of ways.
So, taking a day, taking aminute to really think about you
know what, what if I fill mytank up now so that I can
prevent becoming a bighealthcare burden on, do the
things I love and avoid mentalhealth issues, oh yeah.
Speaker 1 (34:32):
Because, if I'm not mistaken, the statistics are
more men commit suicide thanwomen, I believe, because you
know they bury it so much andlike they have to be strong and
all of that.
So that's something to thinkabout too.
I don't know.
I know that if there is any manthat's listening to this, you
know I obviously put myself infront of all of our patients at
(34:54):
the checkout area, any man thatcame in.
I'm just like I am so proud ofyou that you're here, because,
yeah, not a lot of men do comethrough and they were like it
did take a lot for me to gethere, but now I am happy that I
am here.
Or the ones that have gonethrough there, like that I am
here, or the ones that have gonethrough, they're like I can't
(35:14):
tell you how much happier I amand I actually my husband's two
coworkers have had surgery andthey're just totally different
people and they can work so muchbetter.
Speaker 2 (35:21):
And yeah, and a lot of people and like you've
mentioned this before.
But you don't even know howgood it can get until you do it.
You don't even know what thebenefits can be until your body
is doing it and it's not hardfor you right, yes, like me
taking a two and a half mile run, or walk, not run jog.
Speaker 1 (35:41):
Um, when I'm on call now, I, as long as it's somewhat
nice out um, I'm taking atleast a two mile walk around the
hospital and it's like nothingto me.
I could keep going if it wasn'teight, nine o'clock at night,
but it's just something that isso hard to explain that even
walking up the stairs into workpreviously was hard.
Speaker 2 (36:03):
Absolutely, and that's like again.
It's hard to like know what youdon't know if that makes sense.
And I've experienced this too,where, like it's almost like
learning something right, likeyou learn something and then all
of a sudden it reframeseverything that came before and
this process really for peoplelike I've seen, people who
didn't think that they couldyeah like run a mile or um do,
(36:26):
oh my gosh, what was one thingthere's, I mean, or apply for a
job they didn't think that theywould be able to get, and like,
within a year of doing surgery,they're doing things they just
never thought.
Speaker 1 (36:36):
Just more confident.
I've experienced that.
I'm okay with putting myselfout there.
Speaker 2 (36:41):
Absolutely.
Or like we've had patients whosaid they were able to take care
of a family emergency in a waythat they absolutely would not
(37:03):
have been a year before or sixmonths before surgery.
Yes, yes.
At the same time, I do want tojust one big, big, big like stop
sign, caveat, red flag,whatever.
I never want to be in theposition of.
I never want people to beshamed about their weight and I
don't think it is okay foranybody myself, any other, any
primary doc, anything like thatto bring up weight in a shaming
(37:26):
way for a guy to visit.
So that's not what we'reencouraging.
I don't want anybody to go outthere and say, hey, we heard on
this podcast that we should belike telling every guy who has
extra weight that he's a problemand something needs to be done
about it.
Absolutely not.
What I am saying is this topicshould not just be a woman's
topic or a female centered topic, because men benefit from
(37:47):
treatment when, when they haveextra weight.
That causes issues just as muchpotentially even more than
women do.
So don't avoid the conversationfor men if you have it for
women, and try to be reallymindful and humble about how you
have it.
Speaker 1 (38:01):
And this is just something for a man to think
about as we're closing this out.
You know, us women think aboutthis.
What happens if I'm not able totake care of my kids, or take
care of my spouse, or take careof my parent, or just what
happens if I'm not able to work?
What's going to happen to myhome, my car?
So I know obviously most womenthink about these things daily.
(38:25):
They worry about those things.
So it's just something I wantto put in a man's mind that
might be listening to this ofyou don't want to get to the
point of you can't take care ofyourself, can't take care of
your family, you know, can'tprovide.
So just something to thinkabout that you don't want to get
to the point of not being ableto do it, and then it's a last
resort.
Speaker 2 (38:46):
Absolutely, yeah, absolutely.
So the other, the only otherthing that I'll mention that we
haven't touched on yet is reflux, because reflux is really
really common.
It's heartburn, right?
So, like people have heartburnfrom eating spicy, foods or
laying down and sometimes can'tsleep, or they have coughing, or
you know lots of differentsymptoms.
Guess what can make refluxbetter if you have extra weight
(39:08):
right Losing, weight losing theweight.
So and specifically bariatricsurgery, because you can
actually go in and fix thereasons that are causing reflux
sometimes and definitely theweight loss itself can help with
those symptoms too, and refluxis more common in men than in
women.
So if you have extra weight andyou have reflux, guess what?
You basically bought yourself aticket to having a bariatric
(39:31):
surgery.
That can help with two for likea two for one.
Speaker 1 (39:34):
And I also want to say because I see this all the
time that someone says I haveacid reflux, I have to do a
bypass.
And I want to.
Just I've had to step back andnot write novels on Facebook
groups of just the knowledge Ido have from you and other
surgeons.
But for all of those that arethinking that I have to have a
(39:54):
bypass if I have any type ofreflux, it's not necessarily
true.
Yes, if you have a sleeve it'sgoing to create more pressure
that can cause reflux.
But you've got to think aboutthe weight that you're losing.
That causes the reflux.
So obviously the providers knowbest of if you do have moderate
(40:16):
or severe acid reflux oranything on a scope or whatever.
They're going to push youtowards that bypass.
But just because you have acidreflux every once in a while
doesn't mean a sleeve iscompletely out of the whatever.
Speaker 2 (40:32):
Absolutely.
You're totally right, andthat's kind of um, that's been
something that's been hotlydebated, I would say, in our
communities and our profession,of whether or not somebody with
reflux can have a sleeve.
The answer is yes.
The answer isn't always theanswer is it depends.
It depends absolutely, becauseif you have mild to moderate
reflux and you don't have ahyaluronic or you have a small
(40:52):
one, then a sleeve canabsolutely be a good surgery and
potentially a good firstsurgery.
In the case of, you know,borderline cases, sometimes
people have to be converted tobypasses down the road or other
options, but the weight like yousaid, losing the weight and the
metabolic changes that happeneven with a sleeve, absolutely
can help people to treat andreduce reflux.
(41:16):
In some people, though, you'reabsolutely right, sleeves can
actually cause reflux or canmake it worse.
So that is not aone-size-fits-all approach.
That is a you treat the patientthat you've got with the
options at hand, and that's adiscussion to have with your
provider or for the provider tohave with the patient, right.
Speaker 1 (41:33):
I just wanted people to know that toast because I
have acid reflux means that asleeve is not acceptable.
Nope, not necessarily the case,but yes, case by case.
Speaker 2 (41:44):
Absolutely so.
No, that's a really good pointso.
Speaker 1 (41:47):
I think just to kind of wrap it up is.
Speaker 2 (41:49):
I would love for people to be kind of aware of
bariatric surgery andmedications as a treatment for
weight, especially guys, guys,it really, really helps with a
lot of things and it helps youmore than women in many cases
consider.
And I, you know, I don't expectovernight that everyone will
either know about this orsupport it or make it available.
(42:10):
But if you're interested, reachout to us, reach out to your
local programs and see what itcan do for you, because you
might be really surprised.
Speaker 1 (42:19):
Absolutely.
I'm glad we touched base onthis because I think a lot of
women might be forwarding thisto their significant others or
family member or whatnot,because it is a lot of good
information that this is notjust for women.
So thanks for talking about allof this stuff and, like every
day I'm talking to you, Ilearned something new.
So thank you for all of yourinformation.
Speaker 2 (42:41):
Oh, my goodness, same my love.
All right, you guys.
You guys all have a great restof your day, and it was great to
talk with you, tammy.
Speaker 1 (42:46):
Yes, goodbye, love you.
Welcome to Core Bariatrics Podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tami LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatrics Podcastdoes not offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Hello everybody, Before we getinto the episode, I just want to
apologize for the echo thathappens throughout the episode.
Hopefully you all can getthrough it without having to
turn it off, though if you do,we understand.
(00:43):
But thank you for continuing tolisten and let's get into today
.
Okay, maria, here is anotherday of recording.
Speaker 2 (00:51):
we are so busy we're so busy.
Speaker 1 (00:54):
We're kind of um flying by the seat of our pants
with episodes lately, justbecause we are so busy that
sometimes it's hard to touchbase with each other and record.
Speaker 2 (01:05):
So we're flying by the seat of our pants.
Speaker 1 (01:07):
I feel like we do that a lot anyways, so we've
been successful so far.
Speaker 2 (01:13):
Let me tell our listeners one thing about flying
by the seat of our pants.
I think your version, maybe myversion too flying by the seat
of your pants is the mostorganized version of some
people's lives.
Speaker 1 (01:24):
You know, you're probably not wrong.
Actually, yeah, by flying bythe seat of our pants, we do
have an outline there's anoutline.
Speaker 2 (01:30):
Not only is there an outline, but, like tammy, you
created like a hundred outlinesfor this podcast and done a ton
of background research andyou've gotten interviews with
all kinds of people.
So I think your version offlying by the seat of your pants
is my best day.
Speaker 1 (01:43):
Yeah, you're probably right.
So on one of our last episodeswe started doing fan mail, so
I'm going to start with that andthen we'll go on to.
We're actually going to talkabout men and bariatrics and
surgery and whatnot.
Speaker 2 (01:57):
So, yeah, let's do it .
Speaker 1 (01:59):
All right, let's start with the fan mail here.
We got a message saying can youtalk about food noise, weight
loss shots after surgery due tofood noise?
Um, we'll start with that,because then she also um
discusses or asked and flavoredwater, such as crystal light,
does it make you want sweets,versus having plain water?
She struggles getting water inunless it's flavored, but I also
(02:23):
.
But she also seems to wantsweets, so she battles with
wanting sweets just to have them, but it doesn't actually want
them, if that makes sense, whichit does to me.
So we'll start with the firstthing of talking about food
noise and the why people, or whyphysicians, use weight loss
shots for the food noise.
Speaker 2 (02:44):
Sure, I'm gonna let you run away with that.
Let me run away with that,because I actually will
contradict that just a littlebit, even to begin with.
So uh there's actually somereally great medications on the
market that help with not justweight loss but specifically
this food noise thing and foodnoise.
Let me just explain like whatthat that is, if someone's
wondering what that means, it'sthis constant need to be eating,
(03:07):
this constant feeling andthought of like I want food, I
want to be eating.
What's the next thing I'm goingto?
Speaker 1 (03:13):
eat.
What am I going?
Speaker 2 (03:13):
to be making for dinner oh my gosh, I don't think
I had enough earlier.
And I have actually struggledwith this because I have a
history of an eating disorderand food becomes like one of the
most, if not the most,important thought in your brain,
to the point where it kind ofdisables you from doing other
really important things in lifesometimes like job or school or
(03:34):
you know other things, and uh,it's really a mental, it's
partially mental, it's partiallyphysical.
There's lots of things that gointo that, but it's also
behavioral, like how you, howyou are trained or how you are
raised or how your environmentis structured.
There's kind of a lot offactors there and, to be honest,
the medication I prefer overall of them even over Ozempic
(03:56):
and Majaro and all the GLP-1s isactually Contrave and I think
people kind of forget sometimesthat there's actually 10 FDA
approved medications on themarket for weight management and
Comtree is one of them and it'sa combination of two
medications that were actuallydiscovered for to help people
quit smoking, because it helpswith that kind of obsessive or
(04:19):
overwhelming drive to dosomething, that kind of almost
OCD or anxiety driven need to dosomething, and whether it
affects smoking, it alsoactually affects that desire for
food.
So it actually is one of themost effective medications and
things on the market to tacklefood noise yeah, yeah, and now
explain what contrave is.
Speaker 1 (04:41):
What medications are it?
Because, if I'm not mistaken,there's two, and one of them.
A lot of people tend to be onanyways.
Speaker 2 (04:49):
Yeah, absolutely.
So.
People will be surprised thatit actually.
Yeah, it's a combination of twomedications One is bupropion
and one is naltrexone, andbupropion is also known as
Welbutrin, which is used foranxiety and depression and many
other mental health conditionsand, yeah, also used for it to
(05:09):
help people quit smoking.
Even by itself, it is very,very effective to help people
lose some weight if they've gotextra weight, and to maintain
weight.
And that's actually prettyunusual in the sense of mental
health medications, because mostmental health medications cause
people to gain weight.
So you can only imagine what itwas studied for, uh, to help
people quit smoking.
Typically, when people quitsmoking, they actually gain
(05:31):
weight because, um, there'sthere's kind of a transference
of the, the, the food behaviorwith your mouth Also just
wanting to do something inbetween doing other things or
when you're bored or just havinga habit of of some doing
something, and instead it getstransferred to eating, Right?
So typically people actuallygain weight when they stop
smoking.
But when they stop smokingusing this medication, Contrave
(05:53):
specifically, they actually lostweight and so of course the
company was like immediately onthat and had a study for the
purpose of weight management andweight loss and got it FDA
approved and it's the only typeof medication in its class.
It's actually way less expensivethan the shots, than Ozempic
and the other GLP-1 medications,and it's super underused.
(06:14):
And I am in no way sponsored oraffiliated or anything like
that with Contrave, but I willsay that in my own practice that
has been the number onemedication because it is about
equally effective.
Definitely it's less expensivefor most people, especially
without insurance, and it superaddresses that behavioral and
mental aspect of food noise andwith that I'm so sorry.
(06:35):
I feel like I snuck all the airout of the room with that one,
but no, no, you made a goodpoint there.
Speaker 1 (06:40):
that I wanted to really emphasize is that I feel
like food noise and even DrTeresa Lemasters has talked on
this that food noise really is amental I don't want to say a
mental health issue per se, Iguess, but it's mental right,
and so when you have amedication that's helping you
with that mental aspect, ithelps with that food noise
(07:03):
honestly.
So I have ADHD and my ADHD medskind of helps with that food
noise honestly.
So I have ADHD and my ADHD medskind of help with my food noise
, because without my meds I'mkind of scatterbrained all over
the place.
One of those things is food,where when I do take my meds, I
am very able to focus on work orstuff like that instead of
worrying about what I'm going toeat next.
Speaker 2 (07:23):
Absolutely, absolutely.
And actually Vyvanse is offlabel for weight management and
weight loss in part because ofthat, because a lot of people,
um, who have either foodaddiction or like over snack,
over eat, uh have have kind ofthis food noise also going on,
um, whether it leads to actuallyeating or not, but have the
(07:44):
food noise actually have ADD orADHD or features of that.
So treating that can help withfood noise.
You're absolutely right there.
So I wouldn't say food noise isin and of itself a mental
health condition or issue, butit absolutely is tied to a lot
of a lot of them.
And then not only that, but Ido think in the US especially,
(08:04):
we havea very snacking basedculture yeah, we do.
Speaker 1 (08:08):
Oh my gosh, there's so.
My boss has so many snacks inour office.
I mean chips galore, cookiesgalore.
Speaker 2 (08:14):
I'm like stop it but that's how she shows us her love
.
Speaker 1 (08:20):
honestly, I feel like , yeah, is that she's like thank
you so much for how much hardwork you guys do.
Speaker 2 (08:25):
Here's all the snacks and I'm like oh, I think we
just we come from very fooddriven cultures, even my family,
you know, coming from Russiawhen I was a kid.
We're a very food driven like.
Food is love and sharing foodis love and that's how we build
community.
Speaker 1 (08:40):
Yeah, your Thanksgiving was bombcom.
Speaker 2 (08:46):
Thank you.
I thought so too, thank you,but no.
So food is really, reallycritical in our cultures and the
the.
When we compound that with howbusy we are in our lives, it's
really tough to eat healthy andto eat full meals necessarily
that are full of like all thegood things for you.
So, uh, a snacking culture plusbeing busy plus food noise,
that's just a really tough comboto do without support.
(09:07):
Not to say that everyone needsmedications for that, but
routine definitely helps.
Cutting back where you can onyour schedule to give yourself
space and time to actually eatproperly or snack properly.
Having other kind of go-tos todeal with anxiety stress, like
working out or doing ameditating, doing other things
you really like to do, can help,but definitely medications play
(09:29):
a big role there too.
Speaker 1 (09:30):
I feel like us, as a society of we, are go, go go.
We struggle with mindful eatinglike just mindlessly eating.
Obviously, if I'm charting andof course there's chips next to
me, I'm mind mindlessly eating.
So so I think we kind of touchbase on the food noise thing and
you said you like using thosethe contrave, and some people
(09:53):
use vivance and stuff.
Um, because the weight lossshots?
Now, let's try to touch base onthat as quickly as we can, even
though it's probably a wholeepisode in itself of why those
shots might be used just forfood noise.
Speaker 2 (10:10):
Because I actually want to know the answer.
Yeah, we don't know exactly.
Again, we don't really know themechanism in terms of our
brains and the true like whatparts of the brain, what parts
of the body are interacting forfood noise?
It's probably more complex thanjust one pathway.
We do have an episode where wetalk a little bit more about the
shots, which are also calledthe OP ones like Ozempic.
(10:30):
So I do recommend, if anyone'sinterested in that, that you
kind of go to that episode formore details.
But in the same way thatContrave and other medications
hit that pathway, it seems likethese shots also address that
pathway.
That's not the primary way thatthey work, but that's
definitely one of the ways thatthey seem to work.
And I will say, actually formany people, surgery itself also
(10:53):
addresses that pathway.
It doesn't for everybody, butit does for a majority of people
.
So the combination, especiallyof like surgery plus one of the
medications if you still need itafterwards, can be even more
powerful.
So there's really all, alloptions on the table and if it's
something that you're dealingwith, I really would recommend
(11:13):
talking to a specialist, becauseI don't think this is something
a lot of primary care doctorsor generalist doctors or, you
know, just medical professionalsreally know about or know what
to do about, unless you'retalking to someone specifically
in this industry.
Speaker 1 (11:27):
We're trying to get the word out, but it's not so
quick question with that.
If you knew, if you knew, ifyou had one.
Let's say I came to you as apatient, obviously saying I have
all this food noise and I'mclearly gaining weight and but
you know, my insurance coversthe weight loss injections and I
can get it super cheap.
Would you go towards theinjections or would you still
(11:50):
start with the?
Speaker 2 (11:51):
No, I would still start with Contrave, and
actually we did that.
So, even if people havediabetes, even if people have
conditions like now uh, now, glpones and the other injectable,
the shot medications are coveredin some insurance policies,
even for, like heart conditionsand some other things like Nash
um, which is liver, fatty liverdisease Uh, even if it's covered
for the majority of people, Iwill actually still pick
(12:14):
contrave, and there's a coupleof reasons for that.
It's a pill.
It's tolerated better by mostpeople.
It doesn't have some of theside effects that the
injectables do.
It doesn't slow down thefunction of your gut, which can
be a really big side effect forpeople, especially after surgery
, when the function of your gutis already a little bit altered.
So it really yeah, and there'sdefinitely a subset of people
(12:36):
who have really bad nausea,diarrhea and other GI symptoms
that go along with the shots.
That's just super uncommon tocontrave.
So for all of those reasons, Istill stick with that medication
as my go-to not for everybody.
Everybody is still an individualand this is not advice for any
one individual.
I have to stress that this is apodcast for anyone listening,
(12:57):
so we do not give any individualmedical advice on this podcast,
nor could we.
And all providers are differenttoo, and all providers are
different too, and all providersare different, and so it also
depends on what are peoplecomfortable with?
What do people know about?
Some people who prescribeweight management medications
don't necessarily know as asmuch as others do, or don't have
a have a practice of includingthings like contrave in it.
(13:20):
So, um, I do encourage peopleto look into it, to become as
educated as they can, and it'salso kind of nice that there's
not just one possible treatmentfor this.
There's more than one,especially if people have
insurance coverage or the luxuryof being able to afford things
out of pocket.
So, in a way, like I'm actuallyreally glad that there's not
just a one size fits allsolution.
(13:41):
There's multiple options.
Speaker 1 (13:43):
Absolutely, and I think we have touched base on
this before about the flavoredwater thing, because I told you
that previously I've been ableto drink just plain water and
now, good luck, unless I amliterally dying of thirst, I
need to have crystal light in mywater.
In my water, um, now this lady,that or person that wrote in I
(14:07):
don't know if it's lady but um,does it ask if?
Does it make you want sweetsmore?
Yeah, and I have said that someof the I don't think that the
crystal light does specifically,but if I overdo the fake sugars
, I do find myself wanting sugarmore or sweets more but not
just my flavored water.
Speaker 2 (14:29):
Yeah, you know, and I think it's a matter of a little
bit of a threshold, Like if youlike.
You said like it's not anyamount, it's kind of like if you
overdo it a little bit, I willsay, um, and this is only
because, like, I grew up eatingfood different than the average
American diet.
I grew up eating food that wecooked at home.
That was kind of part of ourculture.
And I will say Russian food ingeneral, or the stuff that I ate
(14:53):
as a kid, is a lot less sweetthan than what's typical in
American culture.
So I think it's a little bit oflike what your palate is used
to.
If you're used to things thatare sweet, you're going to
continue craving things that aresweet.
Speaker 1 (15:05):
If you're used to things that are salty.
Speaker 2 (15:07):
You're going to continue craving things that are
salty, even if your body haschanged.
And then there's also we knowthat this happens again.
We don't know a hundred percentwhy or how or like how to
predict it, but people's tastechanges after surgery.
Um, it can actually changeafter any surgery that affects
the gut, but it really canchange after bariatric surgery,
(15:29):
after weight loss surgery.
So there's when you say that,like you used to drink water
plain and that was great andthat was fine, and now you can't
stomach it.
There's actually some scienceand some truth to that, but we
just don't know why.
Speaker 1 (15:42):
Why?
Yeah, and I will say that.
So Light packet usually goes inlike a 16-ounce bottle.
I'm putting it in a 40-ounceStanley cup, so maybe this
person is putting it in the16-ounce, where it is much
sweeter.
So you could try to water itdown a little more and wean your
way to less sweet.
(16:03):
You don't have to get rid of itper se, but trying to get it
less sweet maybe.
Speaker 2 (16:08):
And the weaning thing is actually really important.
Very little, very few changeshappen overnight successfully,
and when we're trying to changeour behavior, when we're trying
to change like our habits andwhat we eat, what we drink, how
we go about our day, change likeour habits and what we eat,
what we drink, how we, how we goabout our day, it I would
(16:30):
recommend taking a slow approachto those things.
So, let's say you're trying toadd a little bit of plain water,
don't start by, like you know,five extra glasses a day.
You're probably going to bemiserable and be stuck in the
bathroom all day and a lot ofother things.
Instead, try one extra glassand see how it goes for a week
or two, and the same thing withthis.
If you're trying to decreasehow sweet you drink things,
(16:51):
maybe take it down a notch alittle bit and take it down for
a week and see how you feel, andthen take it down another notch
for another week and see howyou feel, because you know how
do you eat an elephant One biteat a time, right, right,
absolutely.
I wouldn't recommendapproaching really any change in
a drastic way, because that isgoing to be a likely setup for
(17:15):
not being able to do it longterm.
Speaker 1 (17:18):
Yeah, I know people that just start drinking a
gallon of water after one dayand they're like never mind, I
can't do that.
I'm in the bathroom constantlyand it's like, well, if you
gradually work up to that gallon, your body knows what to do
with it, but if you just startthrowing water at it, it's like
what is this?
We need to get this out Totally, Totally.
Speaker 2 (17:36):
I mean, like, think of it like almost like a new job
.
Right, If you were supposed to,if you were at the expectation
where that you knew absolutelyhow to do everything in your new
job the first day that you gotthere and you were going to be
perfect at it, then maybe youshould have a different job and
maybe you should be your boss atthat job, so right.
So think of it that way whenyou're making changes, there's a
(17:57):
transition period.
So take it, take it slow andtake it over time.
And that's hard to do becauseit's not like, woohoo, I changed
something overnight, but at thesame time, it'll probably give
you a likelier chance that thatchange sticks.
Speaker 1 (18:11):
You're absolutely right, all right.
So I hope that answered thatperson's question.
So let's move into men andbariatrics.
Yes, do you know what thepercentage of men actually
getting bariatric surgery is?
Speaker 2 (18:26):
I do.
Do you know?
Do you want to guess?
Speaker 1 (18:30):
Honestly, in the year I was in the clinic there was
honestly only five, I think, soI'm going to say 3%.
Speaker 2 (18:42):
Actually it's higher than that.
So it is about 20% overall, butit varies by region.
Speaker 1 (18:48):
And I think that's where this might have been is
because we're in the Midwest orat least our practice was and
try and get these, Nevermind.
Speaker 2 (18:57):
Yes, well, yes, exactly, exactly.
So one is.
That's pretty shocking to mebecause, even though men are
just as likely to be overweightas women, in this country and
globally, like all over theworld, only our patient
population that actually getssurgery is only 20% men, so
that's basically the 80%, fourand five of the people getting
(19:21):
this kind of care are women andonly one in five is a guy, even
though the numbers are the samein terms of who actually deals
with these medical problems, andthere's actually some really
good data that shows that menwho have diabetes or men who
have heart problems or men whohave high blood pressure things
that can be related to weight,especially extra weight they
actually suffer more long-term.
(19:42):
They have higher rates of dyingyounger.
They have higher rates of dyingyounger.
They have higher rates ofhaving complications.
They have higher rates ofhaving higher costs associated
with it and even experiencinglike bad complications, like
amputations, losing a leg.
Speaker 1 (19:55):
You know you're right Now that I'm thinking about my
inpatient population.
Speaker 2 (19:59):
Yes, yes and so, and it's also in part because, like,
men are slightly likelier tosmoke, Men are slightly likelier
to smoke, men are slightlylikelier to have like lower
socio, like social support,which also is a big factor.
Speaker 1 (20:10):
So all these, things.
Speaker 2 (20:11):
It's not just like yeah, and it's not just to say
that, like weight affects menmore, right.
But given the overall pictureof like how men age a little bit
differently than women do,typically the outcomes for men
are worse when they'reoverweight than they are for
women.
Speaker 1 (20:28):
I did not know that.
Speaker 2 (20:30):
So that's all to say.
Where are the guys?
Where are the guys?
What do you think is going onhere, Tammy?
Speaker 1 (20:34):
Well, I was actually just gonna think or just gonna
say do you think some of it hasto do with how and we've touched
, based on this, on an episodetwo of how dad bods are more
accepted than a mom bod per se,or maybe us women just don't
like them as much, I don't knowI don't know, I think there's.
Speaker 2 (20:58):
I mean, it's so complex, right?
Because like we want and as aculture, I feel like we prize
like big, strong, burly dudes.
And some of that is actuallyextra weight, Like it's not
necessarily extra health, it'snot necessarily like extra like
muscle mass.
It's just people being big.
And if people are functional,if people you know are not
(21:19):
having a lot of other healthproblems, and if people are
overall healthy and they likehow they look and they like how
they function, they like howthey work, that's great.
That's not who I'm talkingabout.
What I'm talking about is, um,you're right, Like I don't think
body image is any less bad thanin men, than it is in women.
I think there is just different.
And so the body type of we wantwomen to all be skinny and you
(21:42):
know have have looked likesupermodels on billboards.
And for guys, we want them allto look like lumberjacks, Like
that's kind of the you're notwrong, and lumberjacks is
typically not what you associatewith weight loss or weight loss
surgery, so I do think that isa big part of it that I will.
I think that men especially areworried that if they go into a
(22:04):
weight loss clinic or a weightmanagement clinic and definitely
if they're discussing surgeryor medications that one they're
going to potentially lose toomuch weight, they're going to
end up looking a way they don'twant to look, oh, maybe.
Two, that it's not going towork.
Or three, that they don't wantto be there in the first place.
Right, because there's somereally good stats and data on
(22:27):
this that men in general go getcare less than women do.
Speaker 1 (22:32):
Absolutely, and they wait until it is the last resort
.
Speaker 2 (22:36):
Yes, yes.
So I think that and we've allexperienced that, like I've had
guys in my life family andotherwise I won't call anyone
out specifically who youbasically have to drag on their
deathbed to a clinic or thehospital.
So there's already someresistance to getting medical
care.
That's more in men than it isin women.
(22:57):
And then on top of it you putsomething like weight loss,
which has a lot of stigma andhas a lot of uncertainty and may
be expensive, may be painful,may change your life in ways you
don't necessarily want it to.
So you know, all those thingscombined, I think, make it
really tough for men to feelsupported and encouraged maybe
(23:17):
even by other men to go get thiskind of care, which most
providers are men.
Speaker 1 (23:22):
right, like you are in a man field, right?
Speaker 2 (23:26):
I'm always in a man field.
Speaker 1 (23:28):
So honestly, I feel like a lot of our men patients
did like seeing you as a womanprovider because maybe there was
less judgment there or not,that they felt like there was
less judgment.
Speaker 2 (23:42):
I never thought of that.
Yeah, no, that's actually.
That's pretty insightful of youand I actually had some of our
male patients say that to mespecifically.
They said I'm so glad you're awoman, I'm so glad that you're
taking care of me, I feel morecomfortable with you than if you
were a guy, which I did not.
Those were not comments I eversolicited or encouraged or asked
people for.
(24:02):
But I will say, almost everysingle one of the male patients
I had did say that out loud,even though we didn't prompt
that or anything.
So, there is maybe something tothat, that I think there's this
perception that women who aredoctors or women in healthcare
in general, are just going to bea little bit, maybe, kinder or
gentler or more accepting Maybe.
(24:24):
Maybe that's part of it.
I do think there's somethingthere, because definitely yeah.
Speaker 1 (24:28):
I said we had the best of both worlds in our
program.
We had you and another providerthat were just polar opposites
and there was nothing wrong withit.
I really said this is like thedream team, because some
patients need a provider thatgives them a little extra TLC
and attention and just caringRight.
But then there are somepatients, women and men that
(24:51):
just need to be told this iswhat you're doing, this is what,
and just be harsh and blunt andto the point.
Speaker 2 (24:59):
Yeah, and I think you're absolutely right.
You know there's circumstancesin which harsh and blunt works
well and there's people withwhom that works well.
In general, that doesn't workwell for me because as a woman,
that's just perceived totallydifferently when you do it than
when men do it on average.
So I try not to take that, thatum.
It doesn't come naturally forme with patients at all, so I
(25:19):
don't do that Um.
I will say, though I think thatsome, you know, what's
interesting too is, even though80% of the patients in this
field are women, uh, about 70 to80% of the doctors and the
healthcare providers are men inthis field.
So there's absolutely aflip-flop and that's changing.
So, like in my class, we hadmore, we started to have more
(25:40):
women that were becomingbariatric surgeons, and that
number is only increasing, butwe still have a long ways to go
there.
There's a lot of the hugemajority of people that are in
minimally invasive or bariatricor um anti-reflex surgery or
robotic surgery are men still.
So it's much more likely if yougo to get this kind of care,
that you are going to interactwith a, with a male surgeon, and
(26:03):
I do think that there's somebarriers there with men going to
see a male doctor aboutsomething as personal and
stigmatized as weight.
Speaker 1 (26:14):
Right.
Speaker 2 (26:14):
Um, but let me throw this in there.
So I think one of the thingsthat people don't know but may
change some people's minds isthat weight loss, especially
through bariatric surgery, canimprove your sex life and can
improve fertility.
Speaker 1 (26:30):
Right.
Yes, we have talked about this.
Speaker 2 (26:32):
Yes, we have a whole episode on this, because it's
one of my favorite things totalk about, because so few
people know about it and nourologist knows about it.
No OB guy knows about it.
Very few primary care docs knowabout it and definitely like
very little of the public knowsabout it.
But even though we know, likePCOS, which is polycystic
ovarian syndrome for women canbe treated with this.
(26:54):
For women who have extra weight, it can be treated with
bariatric surgery or with medsmedications for weight loss.
The same thing applies to menIf you have hormonal causes for
extra weight and that thosehormonal causes can also impact
your fertility or your sexualhealth your ability to even get
it up, have an erection havegood sex, and so 201,
(27:16):
essentially patients who gothrough this, male men who go
through this, see an improvement.
Speaker 1 (27:23):
Yeah, that's nothing.
That's something that most menare not thinking about when it
comes to losing weight.
Speaker 2 (27:32):
No, you're right and that and I know you think they
should because you say it asmuch as you- can yeah, because
like think about how much of aself-confidence boost that is,
how much of a again, like ifyou're struggling with fertility
, if you're struggling to have achild with your partner and not
even being like, not evenrealizing that weight and your
(27:53):
metabolism could be a factorright it's a factor that can be
treated and cured potentially.
Speaker 1 (27:57):
Yeah, like that's, I think, a really important
takeaway and I think that justmakes me think that you know, if
a doctor had two obese, anobese couple, come in.
You know both, both heavy, whoare, and they're struggling to
get pregnant.
Who are they looking at first?
Yes, it ain't the man.
(28:19):
They're saying oh, the womanneeds to lose weight.
Speaker 2 (28:22):
Oh, the woman needs, yeah exactly, exactly, and so I
I think that, in general, thehealth care system is, in a way,
almost built to help women andhelp like focus on women in a
way differently than men Maybenot better, but differently and
so we see weight as a problemmore for women than for men.
(28:46):
I think we judge women more forhaving extra weight than we do
men on average not everyone, buton average and I think we, we
dictate to women that they haveto do something about it more
than we do for men.
Yeah, and all of those factors,I think is also like, because
of all of that, uh, there's alot of marketing that goes out
(29:06):
to women, there's a lot ofeducation that goes out to women
, there's a lot of um, eveninsurance policy that goes out
to cover women.
There's a lot of education thatgoes out to women.
There's a lot of um, eveninsurance policy that goes out
to cover women, even though thebenefits are arguably greater
for men, because thecomplications of the extra
weight are higher for men thanthey are for women.
And uh, yeah, so, andespecially for younger men,
(29:28):
because the longer you haveheart problems, the longer you
have diabetes, the longer youhave high blood pressure, the
longer you have hormonalproblems that affect your
fertility, the worse youroutcomes will be over time.
And we also yeah, we do see mendeveloping these problems at
earlier ages than women do.
Speaker 1 (29:47):
And I just feel like men are not scared or approached
about weight and stuff as muchas women are.
We go to our appointment and,honestly, at any time our BMI is
higher than what it should be,they'll say we should lose
weight.
I don't know if that's the casewhen it comes to men as much,
so that's where I feel like menneed to get to the point of
(30:08):
having a heart attack or havingextreme diabetes before a doctor
is like oh, maybe we shouldlook into losing weight.
Speaker 2 (30:17):
Yeah, and you know that's actually.
That brings up a reallyinteresting point, because I
have a personal, personalconnection, personal somebody in
my life who recently had aheart scare, a heart problem,
and it really caused them youbring that up.
It caused them to focus ontheir weight and to actually
start asking about what are theoptions.
Do I consider surgery?
Do I consider medications?
(30:38):
They got on medications andthey did lose some weight and
they feel a lot better.
Um, they may or may not have tostay on their heart medications
, but they're at the point whereactually one of them could be
taken off because they've lostenough weight and the lost
weight also enabled them to bemore active, which enabled them
to be their their heart healthto get even better.
So, that's the other thing tothink about is, when you lose
(30:59):
weight, you're not just losingweight in a vacuum.
You're also losing weight andtherefore sometimes able to move
your body differently,sometimes able to exercise
better, sometimes able to comeoff of other medications,
sometimes you're improvingthings in a way that's not
necessarily like one plus oneequals two, but even more, and
that's really really importantto realize.
(31:20):
And, um, yeah, so I thinkthere's there's a lot to be said
, for it doesn't have to be anemergency or a crisis for
someone to really considerweight as something to tackle
whether you're a man or a woman.
Speaker 1 (31:33):
And, believe me, we welcomed men the same.
Speaker 2 (31:36):
We welcomed men, absolutely the same, and I don't
think we had a single guy whoregretted being there, regretted
going through their process,regretted going through the
procedures.
All of them 201, were like.
I had several cry in my officeafterwards because of the
results that they were seeingand how it was changing their
(31:56):
lives.
So the impact is really massive, can be really massive.
Speaker 1 (32:01):
How do we get them more comfortable of coming in?
Okay, not even just to abariatric program, but to the
doctor in general I think that'ssomething we're not going to be
able to figure out in ourlifetime to talk to some guys.
Yeah, you're not wrong yeah, sowe'll.
Speaker 2 (32:18):
we uh, we actually have a couple of folks lined up
to interview for this in thefuture, um, so that we can truly
talk to some people who, Ithink, have some good ideas
about how we get more men in thedoor and how we get more guys
thinking about this, cause Ithink really, like sex is going
to be a driver, right?
Who?
doesn't want to have better sexin their life and maybe
fertility for some, for some ofthem, um, having babies is a big
(32:40):
driver for younger guys forsure.
Uh, and then overall, justbeing able to like move your
body better and being there forthe people in your life and
being able to do your work andyou know, rocket, be confident,
be satisfied, not have to spenda lot of money on medications,
not have to worry about having aheart attack soon or down the
(33:01):
road.
I mean, I think it's, yes, Ithink there's a lot of reasons
that people could walk in thedoor or could want to, that
people could walk in the door orcould want to, but this is not
a yeah, this isn't, this is notan easy issue.
Speaker 1 (33:14):
No, yeah, those men are not easy.
No, just kidding Us women arenot easy either, but I know, I
know my husband like he doesn'twant to take a day off of work
Right, because he knows he hasto.
Okay, I have a very well-payingjob too, but he knows he needs
to provide for his family and heis also very, very wanting to
(33:35):
make sure he is there for hiswork as well, so he doesn't want
to let anybody down.
So that's when I'm just like ifyou don't go to the doctor, I'm
going to drag you there.
Speaker 2 (33:45):
I love it Well, and it's one of those like put your
oxygen mask on first kind ofsituation.
Before, like put your oxygenmask on first, kind of situation
.
Yeah, I mean like I've seenthis with a lot of guys in my
life a lot of women in my lifetoo, but a lot of guys
especially where you just driveyourself until exhaustion and
then at the point of exhaustionyou're not really useful to
anyone, you're not useful toother people, you certainly
(34:05):
aren't useful to yourself, andgetting to that point is kind of
awful in a lot of ways.
So, taking a day, taking aminute to really think about you
know what, what if I fill mytank up now so that I can
prevent becoming a bighealthcare burden on, do the
things I love and avoid mentalhealth issues, oh yeah.
Speaker 1 (34:32):
Because, if I'm not mistaken, the statistics are
more men commit suicide thanwomen, I believe, because you
know they bury it so much andlike they have to be strong and
all of that.
So that's something to thinkabout too.
I don't know.
I know that if there is any manthat's listening to this, you
know I obviously put myself infront of all of our patients at
(34:54):
the checkout area, any man thatcame in.
I'm just like I am so proud ofyou that you're here, because,
yeah, not a lot of men do comethrough and they were like it
did take a lot for me to gethere, but now I am happy that I
am here.
Or the ones that have gonethrough there, like that I am
here, or the ones that have gonethrough, they're like I can't
(35:14):
tell you how much happier I amand I actually my husband's two
coworkers have had surgery andthey're just totally different
people and they can work so muchbetter.
Speaker 2 (35:21):
And yeah, and a lot of people and like you've
mentioned this before.
But you don't even know howgood it can get until you do it.
You don't even know what thebenefits can be until your body
is doing it and it's not hardfor you right, yes, like me
taking a two and a half mile run, or walk, not run jog.
Speaker 1 (35:41):
Um, when I'm on call now, I, as long as it's somewhat
nice out um, I'm taking atleast a two mile walk around the
hospital and it's like nothingto me.
I could keep going if it wasn'teight, nine o'clock at night,
but it's just something that isso hard to explain that even
walking up the stairs into workpreviously was hard.
Speaker 2 (36:03):
Absolutely, and that's like again.
It's hard to like know what youdon't know if that makes sense.
And I've experienced this too,where, like it's almost like
learning something right, likeyou learn something and then all
of a sudden it reframeseverything that came before and
this process really for peoplelike I've seen, people who
didn't think that they couldyeah like run a mile or um do,
(36:26):
oh my gosh, what was one thingthere's, I mean, or apply for a
job they didn't think that theywould be able to get, and like,
within a year of doing surgery,they're doing things they just
never thought.
Speaker 1 (36:36):
Just more confident.
I've experienced that.
I'm okay with putting myselfout there.
Speaker 2 (36:41):
Absolutely.
Or like we've had patients whosaid they were able to take care
of a family emergency in a waythat they absolutely would not
(37:03):
have been a year before or sixmonths before surgery.
Yes, yes.
At the same time, I do want tojust one big, big, big like stop
sign, caveat, red flag,whatever.
I never want to be in theposition of.
I never want people to beshamed about their weight and I
don't think it is okay foranybody myself, any other, any
primary doc, anything like thatto bring up weight in a shaming
(37:26):
way for a guy to visit.
So that's not what we'reencouraging.
I don't want anybody to go outthere and say, hey, we heard on
this podcast that we should belike telling every guy who has
extra weight that he's a problemand something needs to be done
about it.
Absolutely not.
What I am saying is this topicshould not just be a woman's
topic or a female centered topic, because men benefit from
(37:47):
treatment when, when they haveextra weight.
That causes issues just as muchpotentially even more than
women do.
So don't avoid the conversationfor men if you have it for
women, and try to be reallymindful and humble about how you
have it.
Speaker 1 (38:01):
And this is just something for a man to think
about as we're closing this out.
You know, us women think aboutthis.
What happens if I'm not able totake care of my kids, or take
care of my spouse, or take careof my parent, or just what
happens if I'm not able to work?
What's going to happen to myhome, my car?
So I know obviously most womenthink about these things daily.
(38:25):
They worry about those things.
So it's just something I wantto put in a man's mind that
might be listening to this ofyou don't want to get to the
point of you can't take care ofyourself, can't take care of
your family, you know, can'tprovide.
So just something to thinkabout that you don't want to get
to the point of not being ableto do it, and then it's a last
resort.
Speaker 2 (38:46):
Absolutely, yeah, absolutely.
So the other, the only otherthing that I'll mention that we
haven't touched on yet is reflux, because reflux is really
really common.
It's heartburn, right?
So, like people have heartburnfrom eating spicy, foods or
laying down and sometimes can'tsleep, or they have coughing, or
you know lots of differentsymptoms.
Guess what can make refluxbetter if you have extra weight
(39:08):
right Losing, weight losing theweight.
So and specifically bariatricsurgery, because you can
actually go in and fix thereasons that are causing reflux
sometimes and definitely theweight loss itself can help with
those symptoms too, and refluxis more common in men than in
women.
So if you have extra weight andyou have reflux, guess what?
You basically bought yourself aticket to having a bariatric
(39:31):
surgery.
That can help with two for likea two for one.
Speaker 1 (39:34):
And I also want to say because I see this all the
time that someone says I haveacid reflux, I have to do a
bypass.
And I want to.
Just I've had to step back andnot write novels on Facebook
groups of just the knowledge Ido have from you and other
surgeons.
But for all of those that arethinking that I have to have a
(39:54):
bypass if I have any type ofreflux, it's not necessarily
true.
Yes, if you have a sleeve it'sgoing to create more pressure
that can cause reflux.
But you've got to think aboutthe weight that you're losing.
That causes the reflux.
So obviously the providers knowbest of if you do have moderate
(40:16):
or severe acid reflux oranything on a scope or whatever.
They're going to push youtowards that bypass.
But just because you have acidreflux every once in a while
doesn't mean a sleeve iscompletely out of the whatever.
Speaker 2 (40:32):
Absolutely.
You're totally right, andthat's kind of um, that's been
something that's been hotlydebated, I would say, in our
communities and our profession,of whether or not somebody with
reflux can have a sleeve.
The answer is yes.
The answer isn't always theanswer is it depends.
It depends absolutely, becauseif you have mild to moderate
reflux and you don't have ahyaluronic or you have a small
(40:52):
one, then a sleeve canabsolutely be a good surgery and
potentially a good firstsurgery.
In the case of, you know,borderline cases, sometimes
people have to be converted tobypasses down the road or other
options, but the weight like yousaid, losing the weight and the
metabolic changes that happeneven with a sleeve, absolutely
can help people to treat andreduce reflux.
(41:16):
In some people, though, you'reabsolutely right, sleeves can
actually cause reflux or canmake it worse.
So that is not aone-size-fits-all approach.
That is a you treat the patientthat you've got with the
options at hand, and that's adiscussion to have with your
provider or for the provider tohave with the patient, right.
Speaker 1 (41:33):
I just wanted people to know that toast because I
have acid reflux means that asleeve is not acceptable.
Nope, not necessarily the case,but yes, case by case.
Speaker 2 (41:44):
Absolutely so.
No, that's a really good pointso.
Speaker 1 (41:47):
I think just to kind of wrap it up is.
Speaker 2 (41:49):
I would love for people to be kind of aware of
bariatric surgery andmedications as a treatment for
weight, especially guys, guys,it really, really helps with a
lot of things and it helps youmore than women in many cases
consider.
And I, you know, I don't expectovernight that everyone will
either know about this orsupport it or make it available.
(42:10):
But if you're interested, reachout to us, reach out to your
local programs and see what itcan do for you, because you
might be really surprised.
Speaker 1 (42:19):
Absolutely.
I'm glad we touched base onthis because I think a lot of
women might be forwarding thisto their significant others or
family member or whatnot,because it is a lot of good
information that this is notjust for women.
So thanks for talking about allof this stuff and, like every
day I'm talking to you, Ilearned something new.
So thank you for all of yourinformation.
Speaker 2 (42:41):
Oh, my goodness, same my love.
All right, you guys.
You guys all have a great restof your day, and it was great to
talk with you, tammy.
Speaker 1 (42:46):
Yes, goodbye, love you.
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